Skip to main content

Home Monitoring PT INR Guidelines

The beneficiary requires chronic oral anticoagulation with warfarin for a mechanical heart valve, chronic atrial fibrillation, or venous thromboembolism inclusive of deep venous thrombosis and pulmonary embolism on warfarin.

The patient has been anticoagulated for at least three months prior to use of the home INR device and he/she undergone a face-to-face educational program on anticoagulation management and demonstrated the correct use of the device prior to its use in the home.

The patient continues to correctly use the device in the context of the management of the anticoagulation therapy following initiation of home monitoring and home-testing with the device occurs no more frequently than once a week

Managing Anticoagulation

There are at least three strategies for managing warfarin anticoagulation,

  • Physician office-based testing and management
  • Anticoagulation clinics
  • Home PT/INR monitoring with patient reporting or physician-directed self-management.

Most patients being anticoagulated are managed through physician offices, the "usual care" approach.

Individual physicians manage their patients and PT/INR test frequency is generally once every 4-6 weeks. 

The physician's service is billed with procedure code G0250, no more frequently than once every 4 weeks or every 28 days (7 days/week x 4 = 28 days). There must be 28 days between each submission of G0250.

Clinical Example

  • Patient tests 4 times, on Fridays, in April of 2021
  • The patient tested on April 2, 9, 16, and 23
  • Physician bills G0250 on April 23,2021
  • A physician can only bill G0250 once every 4 weeks (28 days)

Covered ICD Codes

  • I26.93       Single subsegmental pulmonary embolism without acute cor pulmonale
  • I26.94       Multiple subsegmental pulmonary emboli without acute cor pulmonale
  • I48.0         Paroxysmal atrial fibrillation
  • I48.11       Longstanding persistent atrial fibrillation
  • I48.19       Other persistent atrial fibrillation
  • I48.20       Chronic atrial fibrillation, unspecified
  • I48.21       Permanent atrial fibrillation
  • I48.3         Typical atrial flutter
  • I48.4         Atypical atrial flutter
  • I48.91       Unspecified atrial fibrillation
  • I48.92       Unspecified atrial flutter
  • I49.02       Ventricular flutter
  • O88.211    Thromboembolism in pregnancy, first trimester
  • O88.212    Thromboembolism in pregnancy, second trimester
  • O88.213    Thromboembolism in pregnancy, third trimester
  • O88.219    Thromboembolism in pregnancy, unspecified trimester
  • O88.22      Thromboembolism in childbirth
  • O88.23      Thromboembolism in the puerperium       
  • T82.01XA Breakdown (mechanical) of heart valve prosthesis, initial encounter
  • T82.02XA Displacement of heart valve prosthesis, initial encounter
  • T82.03XA Leakage of heart valve prosthesis, initial encounter
  • T82.09XA Other mechanical complication of heart valve prosthesis, initial encounter
  • T82.110A  Breakdown (mechanical) of cardiac electrode, initial encounter
  • T82.111A  Breakdown (mechanical) of cardiac pulse generator (battery), initial encounter
  • T82.118A  Breakdown (mechanical) of other cardiac electronic device, initial encounter
  • T82.119A  Breakdown (mechanical) of unspecified cardiac electronic device, initial encounter
  • T82.120A  Displacement of cardiac electrode, initial encounter
  • T82.121A  Displacement of cardiac pulse generator (battery), initial encounter
  • T82.128A  Displacement of other cardiac electronic device, initial encounter
  • T82.129A  Displacement of unspecified cardiac electronic device, initial encounter
  • T82.190A  Other mechanical complication of cardiac electrode, initial encounter
  • T82.191A  Other mechanical complication of cardiac pulse generator (battery), initial encounter
  • T82.198A  Other mechanical complication of other cardiac electronic device, initial encounter
  • T82.199A  Other mechanical complication of unspecified cardiac device, initial encounter
  • Z95.2         Presence of prosthetic heart valve
  • Z95.3         Presence of xenogenic heart valve
  • Z95.4         Presence of other heart-valve replacement
  • Z95.5         Presence of coronary angioplasty implant and graft
  • Z95.810     Presence of automatic (implantable) cardiac defibrillator
  • Z95.811     Presence of heart assist device
  • Z95.818     Presence of other cardiac implants and grafts
  • Z95.9         Presence of cardiac and vascular implant and graft, unspecified

Tips

  • Self-testing with the device is limited to a frequency of once per week.
  • Testing more frequently than once per week is generally considered not medically necessary.
  • Billing units of service include 4 tests
  • The date of service should be considered as - End date of the final test.

PT/INR - Home Monitoring Codes are, G0248, G0249 & G0250,

  • G0248 - The provider demonstrates the use and care of an INR monitor,
  • G0249 - For home INR monitoring supplies,
  • G0250 - Physician review, interpretation, and patient management of home INR testing for patient 

Note: For the month of May 2021, the physician cannot bill G0250 earlier than 28 days. There must be 28 full days between each submission date.

If G0250 is submitted within 28 days, the claim will be denied.


Check RPM (Remote Patient Monitoring) Guidelines 

Popular posts from this blog

CPT Changes - New CPT Codes '2022

Glimpses of CPT Codes Updates - Effective from January 1st 2022 There are more than 400 codes are changes in 2022 from AMA. Total number codes are changed 405 and including of followings, New Codes -  249  Revised Codes - 93  Deleted Codes - 63 More than 40% of the editorial changes are tried to new technology services described in Category III CPT codes and the continued expansion of the proprietary laboratory analyses section of the CPT code set. Five new CPT codes are created for therapeutic remote monitoring codes 98975, 98976, 98977, 98980 and 98981 to increasingly important avenue of patient care especially during the COVID-19 pandemic. Five new CPT codes are created for complex care management codes 99424, 99425, 99426, 99427 and 99437 a nd there are some changes in chronic care management CPT codes as well. Six new CPT codes are created for Cardiac Catheterization codes 93593, 93594, 93595, 93596, 93597 and 93598 for congenital heart defects. Also, there are some changes in ele

Telehealth Update Medicare - 2022

The listed CPT codes are covered in telehealth and changes are effective from dated on June 16, 2022 Medicare telehealth services require that the services occur over real-time audio and visual interactive telecommunications. For purposes of diagnosis, evaluation, or treatment of mental health disorders. If the patient doesn’t have the technical capacity or the availability of real-time audio and visual interactive telecommunications, or they don’t consent to the use of real-time video technology, we allow audio-only communication for telehealth mental health services to established patients located in their homes. After the PHE ends, Telehealth Mental Health services may include new or established patients so long as an in-person, face-to-face, non-telehealth service takes place within 6 months of the telehealth mental health services. This means that all telehealth mental health patients should have had a first in-person visit no later than 6 months after the PHE. After the PHE and a

Annual Preventive and Wellness Visit Service

Preventive Service Codes The annual preventive exam is a periodic, comprehensive preventive medicine evaluation (or reevaluation) and management of the patient. The CPT Code selection is based on whether the patient is receiving an initial visit -"New Patient" or a periodic - "Established Patient" preventive service, as well as the patient’s age. Initial Visits - 99381, 99382, 99383, 99384, 99385, 99386, 99387 Subsequent Visits - 99391, 99392, 99393, 99394, 99395, 99396, 99397 The Medicare insurance would be covered by "G" codes instead of the above codes. The details below, Welcome to Medicare - G0402 (Within the one year from the patient enrolled in Medicare) Initial Annual Wellness Visit - G0438 (After the 1st year of enrollment) Subsequent Annual Wellness Visit - G0439 Initial Visits Initial comprehensive preventive medicine evaluation and management of an individual including an" age and gender appropriate history, examination, counseling/anticip